Does Intraoperative Frozen Section Diagnosis Correlate with Final Pathology in Borderline Ovarian Tumors

Background: The surgical management of ovarian tumors depends on their correct categorization as benign, borderline or malignant. Ovarian neoplasms are an important cause of morbidity and mortality in women. This study was undertaken to evaluate the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasms. Methods: Intraoperative frozen section diagnosis was retrospectively evaluated in 125 patients with suspected ovarian neoplasms who underwent surgery as primary line of therapy at our institution. This was compared with the final histopathologic diagnosis on paraffin sections. Results: In 125 patients frozen section report had a sensitivity of 100%, 95.55% and 50% for benign, malignant and borderline tumors respectively. The corresponding specificities were 92.45%, 98.75% and 99.14% respectively. The overall accuracy of frozen section diagnosis was 95.2%. The majority of cases of disagreement were in the mucinous and borderline tumors. Conclusion: Intraoperative frozen section has high accuracy in the diagnosis of suspected ovarian neoplasms. It is a valuable tool to guide the surgical management of these patients and should be routinely used in all major oncology centers.

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Accuracy of frozen section diagnosis in ovarian tumors: Is there a change in the course of time?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200309000-00004 ◽

2003 ◽

Vol 13 (5) ◽

pp. 593-597 ◽

Cited By ~ 8

Author(s):

M. Gol ◽

A. Baloglu ◽

S. Yigit ◽

M. Dogan ◽

Ç. Aydin ◽

...

Keyword(s):

Frozen Section ◽

Correct Diagnosis ◽

False Negative ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Frozen Section Examination ◽

Benign Ovarian Tumor ◽

Frozen Section Diagnosis ◽

Accuracy Rates ◽

Higher Sensitivity

A retrospective study of 222 ovarian biopsy results between January 1, 2000 and August 31, 2002 was examined to determine the accuracy of frozen section diagnosis. In addition we reviewed all previous studies that examined the accuracy rates of frozen section diagnosis in ovarian tumors. Histopathologic examination results of frozen section biopsies were concordant with paraffin diagnosis in 92% of all cases. The sensitivity rates for benign, malignant, and borderline ovarian tumors were 98%, 88.7%, and 61%, respectively. There were five (2.2%) false-positive (overdiagnosed), and 13 (5.4%) false-negative (underdiagnosed) patients in frozen section examination. Frozen section examination of mucinous tumors showed higher underdiagnosis rates (20%). Review of previous studies showed no significant variation in accuracy rates of frozen section diagnosis for benign and malignant ovarian tumors, in relation with time. We found low accuracy rates for borderline ovarian tumors which was similar with the previous studies. Hovewer, there were consistent and relatively higher sensitivity rates for borderline ovarian tumors in the recent studies. As a result, we conclude that frozen section evaluation in identifying a malignant or benign ovarian tumor is accurate enough for the correct diagnosis. Since accuracy rates for borderline ovarian tumors are low, we should have more improvement in the correct diagnosis.

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Frozen Section Diagnosis of Ovarian Epithelial Tumors: Diagnostic Pearls and Pitfalls

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0289-ra ◽

2019 ◽

Vol 143 (1) ◽

pp. 47-64 ◽

Cited By ~ 4

Author(s):

Natalia Buza

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Benign Tumors ◽

Ovarian Carcinomas ◽

Intraoperative Frozen Section ◽

Epithelial Tumors ◽

Ovarian Epithelial Tumors ◽

Wide Range ◽

Frozen Section Diagnosis ◽

Section Evaluation

Context.— Epithelial tumors of the ovary are one of the most frequently encountered gynecologic specimens in the frozen section laboratory. The preoperative diagnostic workup of an ovarian mass is typically limited to imaging studies and serum markers, both of which suffer from low sensitivity and specificity. Therefore, intraoperative frozen section evaluation is crucial for determining the required extent of surgery, that is, cystectomy for benign tumors, oophorectomy or limited surgical staging for borderline tumors in younger patients to preserve fertility, or extensive staging procedure for ovarian carcinomas. Ovarian epithelial tumors may exhibit a wide range of morphologic patterns, which often overlap with each other and can mimic a variety of other ovarian nonepithelial neoplasms as well. A combination of careful gross examination, appropriate sampling and interpretation of morphologic findings, and familiarity with the clinical context is the key to the accurate frozen section diagnosis and successful intraoperative consultation. Objective.— To review the salient frozen section diagnostic features of ovarian epithelial tumors, with special emphasis on useful clinicopathologic and morphologic clues and potential diagnostic pitfalls. Data Sources.— Review of the literature and personal experience of the author. Conclusions.— Frozen section evaluation of ovarian tumors continues to pose a significant diagnostic challenge for practicing pathologists. This review article presents detailed discussions of the most common clinical scenarios and diagnostic problems encountered during intraoperative frozen section evaluation of mucinous, serous, endometrioid, and clear cell ovarian tumors.

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Accuracy of Intraoperative Frozen Section Diagnosis of Ovarian Tumors

Gynecologic Oncology ◽

10.1006/gyno.2001.6133 ◽

2001 ◽

Vol 81 (2) ◽

pp. 230-232 ◽

Cited By ~ 56

Author(s):

Paola B.C. Pinto ◽

Liliana A.L.A. Andrade ◽

Sophie F.M. Derchain

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Intraoperative Frozen Section ◽

Frozen Section Diagnosis

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Frozen section diagnosis of borderline ovarian tumors with suspicious features of invasive cancer is a devil’s dilemma for the surgeon: A systematic review and meta‐analysis

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.14105 ◽

2021 ◽

Author(s):

Koen De Decker ◽

Karina H. Jaroch ◽

Mireille A. Edens ◽

Joost Bart ◽

Loes F. S. Kooreman ◽

...

Keyword(s):

Systematic Review ◽

Frozen Section ◽

Meta Analysis ◽

Ovarian Tumors ◽

Invasive Cancer ◽

Borderline Ovarian Tumors ◽

Frozen Section Diagnosis

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Accuracy of frozen section diagnosis of borderline ovarian tumors

Gynecologic Oncology ◽

10.1016/j.ygyno.2011.03.021 ◽

2011 ◽

Vol 122 (1) ◽

pp. 127-131 ◽

Cited By ~ 32

Author(s):

Taejong Song ◽

Chel Hun Choi ◽

Ha-Jeong Kim ◽

Min Kyu Kim ◽

Tae-Joong Kim ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Frozen Section Diagnosis

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The value of frozen section evaluation in the management of borderline ovarian tumors

Journal of Cancer Research and Therapeutics ◽

10.4103/0973-1482.92005 ◽

2011 ◽

Vol 7 (4) ◽

pp. 416 ◽

Cited By ~ 10

Author(s):

Emre Gultekin ◽

Basak Cingillioglu ◽

Muzaffer Sanci ◽

OzgeElmastas Gultekin ◽

Sevil Sayhan ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Borderline Ovarian Tumors ◽

Section Evaluation

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An Evaluation of Frozen Section and Lymph Node Dissection Results for Mucinous Ovarian Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001150 ◽

2018 ◽

Vol 28 (1) ◽

pp. 92-98 ◽

Cited By ~ 4

Author(s):

Marisa R. Moroney ◽

Miriam D. Post ◽

Amber A. Berning ◽

Jeanelle Sheeder ◽

Bradley R. Corr

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Tumor Size ◽

Frozen Section ◽

Ovarian Tumors ◽

Node Dissection ◽

Cross Sectional ◽

Mucinous Histology ◽

Final Pathology ◽

Mucinous Ovarian Tumors

ObjectivesIntraoperative frozen section has greater than 90% accuracy for ovarian tumors; however, mucinous histology has been shown to be associated with increased frozen section inaccuracy. Recent data demonstrate that primary ovarian mucinous carcinomas have no lymph node involvement, even when extraovarian disease is present, and therefore may not require lymph node dissection. Our primary objective is to evaluate the accuracy of identifying mucinous histology on frozen section.Methods/MaterialsA cross-sectional review of mucinous ovarian tumors in surgical patients at one institution from 2006 to 2016 was performed. Cases reporting a mucinous ovarian tumor on frozen section or final pathology were identified. Frozen section results were compared with final diagnosis to calculate concordance rates. Analyses with χ2 and t tests were performed to identify variables associated with pathology discordance.ResultsA total of 126 mucinous ovarian tumors were identified. Of these, 106 were reported as mucinous on frozen section and 103 (97.2%) were concordant on final pathology. Discordant cases included 2 serous and 1 clear cell tumor. Among the 103 mucinous tumors, classification as malignant, borderline, or benign was concordant in 74 (71.8%) of 103 cases, whereas 22 (21.4%) of 103 were discordant and 7 (6.8%) were deferred to final pathology. Lymph node dissection was performed in 33 cases; the only case with lymph node metastasis was a gastrointestinal mucinous adenocarcinoma. Discordance between frozen section and final pathology was associated with larger tumor size and diagnosis other than benign: discordant cases had a mean tumor size of 21.7 cm compared with 14.4 cm for concordant cases (P < 0.001), and 93.5% of discordant cases were borderline or malignant, compared with 30.5% of concordant cases (P < 0.001).ConclusionsIntraoperative identification of mucinous histology by frozen section is reliable with a concordance rate to final pathology of 97.2%. No lymph node metastases were present in any malignant or borderline primary ovarian cases.

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